| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| KEITH BALTZER3 Filed as: KEITH LLOYD BALTZER | PO BOX 71336 SPRINGFIELD, OR 97475 | PACIFICSOURCE HEALTH PLANS | $27K | $0 | $27K | 2.23% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | PACIFICSOURCE HEALTH PLANS | $27K | $0 | $27K | 2.23% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | PACIFICSOURCE HEALTH PLANS | $6K | $0 | $6K | 0.51% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 4.14% |
| KEITH BALTZER3 Filed as: KEITH LLOYD BALTZER | PO BOX 71336 SPRINGFIELD, OR 97475 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $4K | $0 | $4K | 4.14% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $2K | $0 | $2K | 1.73% |
| REBECCA L. HILL3 Filed as: REBECCA L HILL | 1980 HOLLY AVENUE EUGENE, OR 97408 | AFLAC | $3K | $315 | $4K | 8.91% |
| RICHARD E. SYFERT3 Filed as: RICHARD E SYFERT | 86195 PANORAMA ROAD SPRINGFIELD, OR 97478 | AFLAC | $1K | $63 | $1K | 2.81% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | AFLAC | $1K | $0 | $1K | 2.41% |
| JEROMY E. CILLEY3 Filed as: JEROMY E CILLEY | 2683 EAST WILSHIRE DRIVE EUGENE, OR 97405 | AFLAC | $791 | $63 | $854 | 2.04% |
| MJ INSURANCE3 Filed as: JOHN C TAYLOR AND VARIOUS AGENTS | 926 SHERWOOD PLACE EUGENE, OR 97401 | AFLAC | $673 | $0 | $673 | 1.61% |
| GUY R SOUTER3 | PO BOX 1283 LA PINE, OR 97739 | AFLAC | $231 | $0 | $231 | 0.55% |
| CHRISTOPHER EDWARD RUSSELL3 | 3333 SHELTON AVENUE EUGENE, OR 97405 | AFLAC | $225 | $0 | $225 | 0.54% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 6.22% |
| KEITH BALTZER3 Filed as: KEITH LLOYD BALTZER | PO BOX 71336 SPRINGFIELD, OR 97475 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $1K | $0 | $1K | 6.22% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $560 | $0 | $560 | 2.56% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $982 | $0 | $982 | 6.22% |
| KEITH BALTZER3 Filed as: KEITH LLOYD BALTZER | PO BOX 71336 SPRINGFIELD, OR 97475 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $982 | $0 | $982 | 6.22% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $402 | $0 | $402 | 2.55% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $934 | $0 | $934 | 6.33% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $934 | $0 | $934 | 6.33% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $347 | $0 | $347 | 2.35% |
| BACKLUND & ASSOCIATES PC3 Filed as: BACKLUND AND ASSOCIATES PC | 1500 VALLEY RIVER DRIVE, SUITE 300 EUGENE, OR 97401 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $330 | $0 | $330 | 6.39% |
| KEITH BALTZER3 Filed as: KEITH LLOYD BALTZER | PO BOX 71336 SPRINGFIELD, OR 97475 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $330 | $0 | $330 | 6.39% |
| MJ INSURANCE3 Filed as: MJI INC | PO BOX 847 MCMINNVILLE, OR 97128 | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | $115 | $0 | $115 | 2.23% |
No Schedule C service providers reported on this filing.
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 114 | Currently employed and enrolled or eligible. |
| Retired/separated still receiving benefits | 4 | Continuation coverage (COBRA, retiree health). |
| Retired/separated still eligible | 0 | Vested but not currently using benefits. |
| Total participants (= "Plan participants" tile) | 118 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Health (medical) | PACIFICSOURCE HEALTH PLANS | 178 | $1.2M |
| Dental | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 108 | $88K |
| Vision | PACIFICSOURCE HEALTH PLANS | 178 | $1.2M |
| Life insurance(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 114 | $37K |
| Short-term disability(2 contracts, 2 carriers) | AFLAC | 45 | $47K |
| Long-term disability | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 114 | $16K |
| Prescription drug | PACIFICSOURCE HEALTH PLANS | 178 | $1.2M |
| Other(2 contracts) | THE LINCOLN NATIONAL LIFE INSURANCE COMPANY | 114 | $37K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 178 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Top carrier holds >85% of premium. If that carrier hits a rate increase, the entire plan moves.
Schedule A presence shifted between filings (insured ↔ self-funded, or new contracts added/removed). Capture the transition window.